Referral to emergency

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

  • fracture or suspected fracture

Please contact the on-call registrar to discuss your concerns prior to referral.

For clinical advice, please telephone the relevant specialty service.

Northern Adelaide Local Health Network

Southern Adelaide Local Health Network

Women's and Children's Health Network

Exclusions

  • symmetrical bilateral bowlegs in a child under 3 years of age with intercondylar separation < 6 centimetres

Triage categories

Category 1 (appointment clinically indicated within 30 days)

  • nil

Category 2 (appointment clinically indicated within 90 days)

  • after traumatic event, bow legs following healed fracture
  • ongoing pain in lower limbs
  • new onset of bow legs in a child ≥ 3 years of age

Category 3 (appointment clinically indicated within 365 days)

  • persistence of bow legs after three years of age
  • intercondylar separation is > 6 centimetres
  • asymmetrical deformity, unilateral deformity
  • progressive deformity or lack of resolution
  • other associated skeletal deformity such as height below fifth centile for age
  • multiple joint involvement or other skeletal deformities
  • joint movement limitation

Essential referral information

Completion required before first appointment to ensure patients are ready for care. Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.

Clinical history

  • details of presenting condition including onset and duration of symptoms
  • history of infection, trauma, fracture
  • management to date and response to treatment
  • past medical history and medications
  • risk factors for rickets
  • relevant family history related to this condition i.e. siblings/parents with same condition

Physical examination

  • growth parameters
  • measurement of intercondylar distance in standing with feet together
  • observation of gait

Additional information to assist triage categorisation

  • dietary and vitamin intake
  • any blood results, e.g. calcium, magnesium, phosphate, corrected calcium, albumin, parathyroid hormone, vitamin D levels if severe bowing

Clinical management advice

  • Reassure parents that physiological bow legs will resolve by age three with normal development. No specific treatment is required.
  • If concerned, serial measurement of intercondylar distance every six months to document progression or resolution may be useful.
  • Consider vitamin D deficiency, measure blood levels if concerned.

Clinical resources

Consumer resources

Reason for request

  • to establish a diagnosis
  • for treatment or intervention
  • for advice and management
  • for specialist to take over management
  • for a specified test/investigation the General Practitioner cannot order
  • for other reason (e.g. rapidly accelerating disease progression)
  • transfer of care from another tertiary service
  • clinical judgement indicates a referral for specialist review is necessary.

Patient demographic details

  • full name, including aliases
  • date of birth
  • residential and postal address
  • telephone contact number/s – home, mobile and alternative
  • Medicare number, where eligible
  • name of the parent or caregiver, if appropriate
  • preferred language and interpreter requirements
  • identifies as Aboriginal and/or Torres Strait Islander

Clinical modifiers

  • impact on employment
  • impact on education
  • impact on home
  • impact on activities of daily living
  • impact on ability to care for others
  • impact on personal frailty or safety
  • identifies as Aboriginal and/or Torres Strait Islander

Other relevant information

  • Willingness to have surgery, where surgery is a likely intervention.
  • Choice to be treated as a public or private patient.
  • Compensable status, e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.
  • Relevant social history, including identifying if you feel your patient is from a vulnerable population, under guardianship/out-of-home care arrangements and/or requires a third party to receive correspondence on their behalf.
  • Triage of a specialist outpatient referral is based on clinical decision making to allocate an appropriate urgency categorisation.
  • Where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service. Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
  • A change in patient circumstance (such as condition deteriorating or pregnancy) may affect the urgency categorisation and should be communicated as soon as possible.
  • All new referrals will be triaged by a consultant and appointment times scheduled according to clinical urgency.

Adolescents transitioning from paediatric to adult specialist services require a formal handover from paediatric specialist clinician to adult specialist clinician as well as a formal referral from the referring specialist to ensure initial transfer of care is completed.

The role of the referring clinician (e.g. General Practitioner, Nurse Practitioner) in this process is to provide support to patients as part of holistic care. All ongoing referrals to specialists can subsequently be provided by the referring clinician once the transfer of care has occurred.